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Thursday, July 8, 2010


Finally, a Medicare/Medicaid Chief

Published: July 7, 2010

The New York Times  Op - Ed, today


"President Obama made a sensible move Wednesday when he bypassed the Senate and appointed Dr. Donald Berwick, an expert on reducing health care costs, to oversee Medicare and Medicaid. Republican senators had made it clear that they would use confirmation hearings to distort his record and rehash their arguments against the recently enacted health care reforms, mostly to score political points for the November elections.

By using his power to make recess appointments while the Senate is on vacation, Mr. Obama put Dr. Berwick in a position of vital importance in implementing the new reform law. His appointment will run until late 2011, giving him time to get things moving before he would have to be renominated. The Centers for Medicare and Medicaid Services, which Dr. Berwick will run, has been without a permanent administrator since 2006.

The obscure but influential agency runs two huge public insurance programs that will play central roles in health care reform. The new law requires Medicare for older Americans and the disabled to become more efficient and to serve as a testing ground for innovations to improve the quality and lower the cost of health care, the core of Dr. Berwick’s professional interests. Reform will also entail a big expansion of the state-federal Medicaid program for the poor, requiring strong guidance and leadership from Washington.

Dr. Berwick’s major credential for the job is that he leads the Institute for Healthcare Improvement, a consulting group that promotes measures to improve the quality and safety of health care while reducing its costs. He has been enormously successful at getting health care professionals and institutions to work together to reform their practices — exactly what the agency needs.

His appointment is backed by the American Medical Association, the American Hospital Association and scores of other health organizations and patient advocacy groups. He has been endorsed by three predecessors who held the same job in Republican administrations.

Even so, some Republican senators have portrayed Dr. Berwick as a proponent of socialized medicine because he has expressed great admiration for Britain’s National Health Service. They also call him an advocate of rationing care and even suggest he favors “death panels,” a politically potent falsehood.

Yet Dr. Berwick spoke an obvious truth when he declared that “the decision in not whether or not we will ration care — the decision is whether we will ration with our eyes open.” Care is already rationed by insurance company decisions about what services to cover and by high prices that make insurance and medical care unaffordable to millions of Americans.

Senators jealous of their prerogatives in confirming presidential nominations are grumbling about being bypassed. But there is no telling when or whether the Senate would have been ready to confirm Dr. Berwick. The job is too important to leave open any longer. "

For the record, a serious conversation about Berwick’s qualifications and plans would have been worthwhile. I’ve heard even people sympathetic to Berwick question whether his administrative experience is adequate. But, again, it’s hard to have a serious conversation when one of the two political parties refuses to be serious.

The Dems were well within their rights to use the recess appointment mechanism (as the Bushies did hundreds of times in their day), just as they were to use the reconciliation mechanism to pass the healthcare reform bill. Of course, the GOP is now completely free to paint the Berwick appointment as unacceptably anti-democratic. Who’s right? Who cares? The voters will ultimately decide.

Some or all of the above may be true, but why the rush to the appointment.  Some of those recommendations come from previous temporary heads of CMS. So, why didn't they keep their job?

The American  People deserve to hear the questions from their elected representatives, and answsers from Dr. Berwick, both about positive and negative attributes of this highly achieved and touted academician.

It has been shown the AMA represents only about 115,000 physicians out of over 800,000 physicians, most are students,  and academicians.

Senators are not 'jealous of their prerogatives" they have the sworn duty to represent their constituents.

As  usual the NY Times is highly biased in favor of liberal social agendas, rather than expressing any discontent with President Obama's wanton disregard of procedural matters.


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